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Sunday, September 14, 2025

ADHD (Attention Deficit Hyperactivity Disorder)


Attention Deficit Hyperactivity Disorder (ADHD) – Treatment Options

Introduction
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with academic, occupational, and social functioning. ADHD presents in three clinical subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined. The condition begins in childhood and often continues into adolescence and adulthood. Management is multimodal, combining behavioral interventions, educational support, lifestyle adjustments, and pharmacotherapy.

1. Behavioral and Psychosocial Interventions

  • Behavioral therapy:

    • Parent training in behavior management techniques.

    • Classroom-based behavioral interventions (structured routines, positive reinforcement).

  • Cognitive-behavioral therapy (CBT):

    • Improves organization, problem-solving, and coping strategies.

    • More effective in older children, adolescents, and adults.

  • Social skills training: For children with difficulties in peer relationships.

  • Educational support:

    • Individualized education programs (IEPs) or 504 accommodations in school.

    • Reduced distractions, extended test time, and structured learning environments.

2. Pharmacological Therapy

  • Stimulants (first-line):

    • Methylphenidate (short-, intermediate-, or long-acting).

    • Amphetamines (dextroamphetamine, lisdexamfetamine, mixed amphetamine salts).

    • Mechanism: Enhance dopamine and norepinephrine signaling in the brain.

  • Non-stimulants (second-line or adjunct):

    • Atomoxetine (selective norepinephrine reuptake inhibitor).

    • Guanfacine and clonidine (alpha-2 adrenergic agonists, useful in children with tics, aggression, or sleep problems).

    • Bupropion (off-label, particularly for adults with comorbid depression).

  • Considerations:

    • Medication titration is individualized.

    • Regular monitoring for side effects such as appetite suppression, insomnia, elevated blood pressure, or mood changes.

3. Lifestyle and Supportive Measures

  • Routine and structure: Consistent schedules to minimize distractions.

  • Physical activity: Improves attention, impulse control, and mood.

  • Nutrition: Balanced diet; some children may benefit from limiting processed foods or additives.

  • Sleep hygiene: Regular sleep schedules to improve concentration and reduce irritability.

  • Family education and counseling: To reduce stigma and support adherence.

4. Monitoring and Long-Term Care

  • Regular follow-up: Assess symptom control, growth (in children), cardiovascular status, and school/work performance.

  • Medication review: Adjust therapy for effectiveness and tolerability.

  • Transition care: From pediatric to adult services as adolescents age.

  • Comorbidity management: Screening for anxiety, depression, learning disorders, oppositional defiant disorder, or substance misuse.

5. Multidisciplinary Care

  • Psychiatrists/neurologists: For diagnosis and pharmacologic management.

  • Psychologists/therapists: For behavioral and cognitive interventions.

  • Teachers/educational specialists: For academic accommodations.

  • Primary care providers: For growth and cardiovascular monitoring.

  • Social workers/counselors: For family support and community resources.



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